Provider Demographics
NPI:1134498280
Name:NEWPORT NEUROHOSPITALIST MEDICAL GROUP
Entity Type:Organization
Organization Name:NEWPORT NEUROHOSPITALIST MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-764-1454
Mailing Address - Street 1:PO BOX 15847
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-5847
Mailing Address - Country:US
Mailing Address - Phone:949-574-4638
Mailing Address - Fax:949-574-4680
Practice Address - Street 1:19191 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-4670
Practice Address - Country:US
Practice Address - Phone:877-969-7376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06000055310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility